Health

Many of World Vision’s investments to build healthy communities rely on community health workers (CHWs). CHWs are knowledgeable about basic healthcare but do not have a professional medical license. World Vision equips CHWs with training, curriculum, and tools to promote healthy practices, treat common illnesses, and help connect the community to health facilities.

While the role of CHWs within the health system varies from country to country, they are a crucial link between the communities they serve and the larger health system. World Vision specifically equips CHWs to deliver the following:

Integrated community case management (iCCM) is a strategy to train, support, and supply CHWs to diagnose and treat multiple illnesses for families with difficult access to case management at health facilities. More than half of under-5 child deaths are due to diseases that are preventable and treatable through simple, affordable interventions. However, delivery of health services is often weakest where the needs are greatest. In most high-mortality countries, facility-based services alone do not provide adequate access to treatment and, most importantly, not within the crucial window of 24 hours after the onset of symptoms. According to the World Health Organization, “malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illness such as diarrhea, pneumonia, and malaria. Nutrition-related factors contribute to about 45% of deaths in children under 5 years of age.”

However, the correct and timely treatment of childhood pneumonia, diarrhea, and malaria is one of the most powerful interventions to reduce mortality. We join communities to advocate with governments, the private sector, and civil society for iCCM services to bring curative healthcare to children in communities that are hardest to reach. In partnership with ministries of health, we build the capacity of CHWs and support them to ensure that community-based services are available for those who need them the most.

Timed and targeted counseling is a family-inclusive behavior change communication approach targeting families of young children, especially the most vulnerable and marginalized. Timed and targeted counseling encompasses a wide range of lifesaving health practices through appropriately timed messages delivered using interactive storytelling. The approach uses a dialogue-based counseling methodology, assessing current needs and practices and working toward progressive improvements when gaps are identified. Importantly, timed and targeted counseling seeks to engage both parents and decision makers, embracing a family-inclusive and gender-transformative model of child health and development in which the positive contribution of fathers is emphasized. Timed and targeted counseling can be done by many community members, including officially recognized CHWs, guide mothers, or volunteers.

Community-based management of acute malnutrition (CMAM) is a methodology for treating acute malnutrition in young children using a case-finding and triage approach. It was developed by Valid International and has since been endorsed by the U.N. (UNICEF and WHO) and USAID. The CMAM method enables community volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill. Caregivers treat the majority of children with severe acute malnutrition in the home using Ready-to-Use-Therapeutic Foods and routine medical care.

Digital health innovations help CHWs, clinics, and hospitals collect and analyze information and make the best health decisions for program participants, especially in places where access to healthcare is limited.

Learn more about how our CHWs helped reduce malnutrition rates in Zambia.

Since 2005, World Vision’s Citizen Voice and Action (CVA) approach has been used in more than 700 programs in 48 countries, resulting in improvements in several thousand health clinics and schools, as well as improvements in water access, extension services, and child protection. CVA fosters social accountability by educating citizens on the basic service rights their governments have promised them and facilitating the community to develop a scorecard of the availability and adequacy of services in their area. Communities use their scorecard to rate their satisfaction with services, work with decision makers to review data, and develop action plans for improvements. They continue to work with the government and local partners to ensure that agreed commitments are met.

The CVA approach has a solid and proven evidence base of change that has been influenced and informed by many years of use in the health sector. An evaluation of CVA in our Nobo Jatra program in Bangladesh found that CVA led to remarkable achievements and “inspired institutional actors to overcome inertia and find motivation to improve their job performance.” The approach helped local institutional actors to organize and coordinate themselves to improve service delivery in more creative ways, which had a “trickle-up” effect to higher levels of government. One promising finding was that 88% of community health clinics targeted were meeting government standards after the CVA approach was introduced, compared to only 49% before the approach was employed. Read more in this summary of the findings.

Community-based monitoring provides visibility on the performance of community systems, demonstrates how they are working, and indicates where improvements are needed. While the data is often used for understanding highly localized patterns, it can be difficult to translate for use at higher levels to inform policy and governance supporting community systems, because the local data is not generalizable to broader regions.

Within the framework of Citizen Voice and Action (see previous question), World Vision assists communities to aggregate community-level data and identify patterns in the performance of public services at district and regional levels.

Our principle of working with communities and national governments fosters partnerships and prioritizes capacity building, collaborating, and learning and adapting for strategic approaches to reach scale. We focus on crosscutting issues, including gender equality and social inclusion, in our approach to HSS.

Our strategic approaches to HSS, with particular focuses on district and community levels, are based on the following:

• Strengthening the performance of priority health system components that are relevant for effective delivery of health programs
• Fostering synergies among the health programs by promoting integrated approaches to planning, programming, and service delivery
• Building the capacity of health systems to scale up integrated service delivery platforms and improve quality, equity, efficiency, effectiveness, and sustainability of services, particularly in hard-to-reach areas and those targeting key affected and underserved population groups
• Improving the managerial capacity of the entire health system at all levels, with an emphasis on district and community levels, through support to procurement and supply chain management, integrated health information systems, human resources training and supervision, and financial management
• Supporting community and civil society actors, including community health workers, as well as the private sector, to enhance their engagement in the HSS and health programs
• Working toward addressing gender inequalities and human rights issues through relevant legal, policy, and regulatory frameworks

Our HSS projects intend to build service capacity in target health facilities at all levels (national and subnational), to deliver quality health services to communities. This is normally done by supporting the local Ministry of Health’s National Health Sector Strategic Plan, with the vision of having a functional health system contributing to the six pillars of HSS (leadership/governance; service delivery; health system financing; health workforce; health information systems; and medical products, vaccines, and technologies).

We train healthcare providers in standard health services, supply/inventory management, correct use of medicines and medical equipment, on-the-job mentoring of trained healthcare providers, and development of quality healthcare through supportive supervision, ideally incorporated into district health management teams’ supportive supervision and monitoring strategies. Our approach aims to improve the quality and accessibility of services, focusing on priority interventions to reduce mortality and morbidity. World Vision’s interventions and technical assistance engage communities to advocate for and contribute to the development and implementation of an essential health package centered around community‐based approaches and integrating essential services to reach all members of the community, especially women and other marginalized populations.

World Vision uses existing methodologies for engaging communities to give feedback and improve quality and accessibility of services. These include:

• Citizen Voice and Action increases citizens’ knowledge of rights to health services and allows for collaboration to secure those rights. This model strengthens the environment for continual feedback and communication between the national government and the local government, and between the local government and communities.
• Channels of Hope is an interactive process to create a safe space for faith leaders, their spouses, and faith communities to actively engage on health issues through science-based information and insight from religious texts that enable them to respond to some of the most difficult issues affecting their communities.
• Integrated community case management utilizes trained, supervised community members, linked to facility-based services, to deliver curative interventions in the community. They may perform their duties from their homes, a community-constructed building, or government or private health facility. Integrated community case management is a strategy to train, support, and supply community health workers to diagnose and treat multiple Illnesses, specifically pneumonia, diarrhea, and malaria for sick children of families without easy access to case management at health facilities.
• Community-based management of acute malnutrition supports communities to identify and treat acute malnutrition and wasting. This includes the creation of an mHealth application to help improve treatment, reporting, and monitoring of acute malnutrition.
• Community health committees build the capacity of and empower local health committees to coordinate activities that increase community capacity, improve health policy and service environment, and support community health worker programs. Taken together, these improvements lead to strengthened community health systems and positive health outcomes.

Our mission to enable children, families, and communities to reach their full potential cannot be realized without addressing the root issues of inadequate pregnancy spacing in many of the communities in which we work, which is often rooted in the lack of accurate knowledge of and/or access to contraception methods. World Vision’s efforts around voluntary family planning are directed at helping women achieve healthy timing and spacing of pregnancies, to give them and their children the best chance of survival. Risk of birth complications that result in maternal and newborn morbidity and mortality are drastically reduced when pregnancies are delayed until after the age of 18, limited after the age of 35, and spaced at intervals of two or more years.

When a woman delays pregnancy until she is at least 18 years old, not only will she be mature enough to give birth to a full-term, healthy baby; she’ll also be more likely to remain in school to pursue education and a career, increasing her ability to contribute to the economic health of her family. For subsequent births, children conceived 24 to 59 months after a previous birth have the lowest risk of dying in infancy. The time between pregnancies can also allow the baby to benefit from being breastfed longer. And when the mother is able to spend more time with each child, this contributes to the child’s physical, mental, and emotional development.

Child marriage (or “early marriage”) often results in early first pregnancy and closely spaced subsequent pregnancies and births, which are among the most frequent causes of infant and maternal mortality and abortion in developing countries. In order for World Vision to fulfill its mission, addressing the family planning needs of the communities in which we work is paramount. Family planning is not only a health issue for mother and child, but has ramifications for gender equality, women’s economic empowerment, education opportunities for children, child protection (as young girls are married off or children sent to work as a coping mechanism), food security for the whole family, and virtually every other aspect of life.

Despite evidence showing family planning’s impact on the health and socioeconomic status of women, girls, and their communities, some 218 million women and girls in low- and middle-income countries who want to avoid pregnancy are not using a modern method of contraception. An estimated 85 million women who become pregnant every year do not want to be pregnant. About half of those pregnancies — 42 million — end with an induced abortion. More than 67,000 women and girls die because of abortion-related injuries — and millions more suffer complications and long-term injuries. Abortion-related injuries account for 13% of maternal deaths worldwide.

HTSP and voluntary use of contraceptive services promotes life, health, and well-being by reducing neonatal, infant, and child deaths; preventing maternal deaths, unintended pregnancies, and abortions; and helping families achieve their desired timing and spacing of pregnancies. Regardless of when pregnancy occurs, World Vision promotes child and maternal survival, supporting women and their families to receive optimal antenatal care, skilled birth attendance, and care of the baby postpartum.

World Vision uses several approaches to impact how communities view family planning that target changing attitudes at community, household, and individual levels. At the community level, World Vision works with faith leaders through Channels of Hope to help them champion family planning in faith communities, engage men and women about the benefits of family planning, and promote HTSP within their theological framework. Faith leaders provide accurate information to reduce misconceptions and misinformation and address social and cultural norms that hinder acceptance of modern contraception. At the household and individual levels, we integrate family planning messages in our maternal, newborn, and child health counseling, Nurturing Care Groups, and timed and targeted counseling to link women and their households with important education and social support to adopt healthy practices, including HTSP and family planning.

In Ghana and Kenya, we conducted operations research on the Channels of Hope (COH) Methodology to gauge COH effectiveness to move faith leaders to support HTSP. Results among faith leaders in both countries indicated their knowledge on HTSP changed due to the COH workshops. In addition, family planning methods supporting HTSP with the highest knowledge increases between intervention areas and control areas were implants, injectables, and pills, with 18.4, 12.1, and 11.2 percentage point increases, respectively.

Kenya: In West Pokot and Isiolo counties, World Vision partnered with The Pfizer Foundation to implement the Increasing Use of Family Planning and Immunization Services through Program Integration project (2016-2019) to increase the uptake of family planning and immunization through integrated service delivery and community engagement strategies. At the facility level, World Vision trained providers on HTSP and contraceptive services and immunization through same day, co-located services and trained community health volunteers to counsel and record updates of HTSP/family planning and immunization during monthly household visits. At the community level, World Vision catalyzed Christian and Muslim faith leaders as community advocates to improve HTSP, immunization coverage, and male engagement, and we equipped community leaders to advocate for increased resources from the Ministry of Health.

The project:

• Reached a total of 39,016 women and 34,067 men with family planning counseling or education.
• Counseled 20,503 women on family planning (through health workers) as they attended routine child immunization services
• Demonstrated statistically significant increases in immunization coverage in both project areas: from 51.2% to 82.7% in Isiolo and from 32.3% to 61.2% in West Pokot.

This project was featured in a number of journal articles:

• “Perceptions of Quality and the Integrated Delivery of Family Planning with Childhood Immunisation Services in Kenya and Uganda”
• “‘It was my own decision’: The Transformational Shift That Influences a Woman’s Decision to Use Contraceptives Covertly”
• “As a woman who watches how my family is … I take the difficult decisions’: A Qualitative Study on Integrated Family Planning and Childhood Immunisation Services in Five African Countries”
• “Context-Acceptability Theories: Example of Family Planning Interventions in Five African Countries”

World Vision’s mission is to ensure that every child experiences life to its fullest — therefore, the well-being of children, women, and their families is at the core of our work. For children to attain their fullest potential in life, the mother must receive high-quality antenatal care, optimal care during childbirth (with access to emergency care), and postnatal care. In addition, for children to thrive and survive, mothers and caregivers must have access to health promotion, disease prevention services, and timely treatment of common childhood illnesses.

The World Health Organization estimates that 810 women die each day from complications during pregnancy and childbirth. Ninety-four percent of maternal deaths occur in low- and middle-income countries, which is where most of World Vision’s work takes place. For every woman who dies of pregnancy-related causes, many more suffer from morbidity, disabilities, and long-term ill-health. A woman’s death during pregnancy or childbirth threatens her newborn’s chance of survival, lowers her other children’s chances for survival and education, and threatens her family’s stability.

World Vision designs and supports whole health systems programming that addresses MNCH through a continuum of care and a life-cycle lens. Our programs are guided by global health principles that are evidence-based, aligned with government policies, people-centered, equity-driven, gender-responsive, accessible by the most vulnerable communities, sustainable, and accountable.

World Vision programs focus on three pillars that support MNCH: social and behavior change to encourage demand for high-quality MNCH; health system strengthening to support person-centered service delivery; and enabling environments created through community-led accountability mechanisms.

Zambia: The Survive to Thrive maternal and child health program is funded by private individual donors. The project originally focused on one district and aimed to reduce morbidity and mortality for women of child-bearing age and children under 5 in the Luwingu district of Zambia’s Northern province. Luwingu was selected as the focus area due to its child mortality rates, as well as excessive stunting rates (8%–10% higher than the national average of 40%). This project utilizes a two‐pronged approach that focuses on proven preventive care interventions such as social and behavior change and improving access to quality care and treatment, with an emphasis on providing piped water to points of care and making sanitation and hygiene improvements at local health facilities. The programmatic success and partner support enabled the program to increase its aim of providing clean water and healthcare improvements at every healthcare facility where World Vision works.

Key results to date include:

• 51,704 women and 29,251 children under 5 have been directly reached through project interventions.
• The proportion of births attended by skilled birth attendants increased from 83% at baseline to 94% at midterm.
• The proportion of sick children who were taken to an appropriate provider, as defined by national protocols/guidelines, increased from 9.2% at baseline to 66% at midterm.
• Over 15,000 children under 5 have been screened and treated for malaria, pneumonia, or diarrhea.
• 19 clinics in Luwingu district (an increase from our original target of nine) now have access to safe water within the facility, handwashing and sanitation infrastructure, supplies, and staff training.
• Project achievements led to scaling up a national-level plan to provide piped water inside the premise of every healthcare facility within existing World Vision area programs.

Check out these videos for more on the Survive to Thrive project

Niger: The Act 2 Save project aims to reduce the high mortality rates of children under 5 in six communes in the Dosso and Maradi regions. The project is funded by private individual donors and was originally focused on two regions, but is now scaling across World Vision Niger area programs. In alignment with the government’s strategy, the project is helping address the leading contributors to these deaths, mainly preventable infectious diseases such as malaria, diarrhea, and pneumonia. Additionally, about a third of all deaths in children under 5 occur in the perinatal and infancy period, with leading contributing factors including neonatal sepsis, birth asphyxia, and congenital causes (and bearing in mind that only two out of five deliveries occur in health facilities). As such, solutions are implemented in health facilities and communities.

The project trains and equips community health workers (CHWs) to diagnose and treat pneumonia, malaria, and diarrhea with the integrated community case management (iCCM) approach, and invests in health facility improvements with an emphasis on water, sanitation, and hygiene infrastructure, training, and enabling environment.

To date:

• 400 CHWs are trained and actively providing iCCM services for 67,500 children in 206 villages.
• A partnership was finalized with the University of North Carolina Water Institute to evaluate operation and maintenance strategies for WASH in healthcare facilities based on existing literature and Niger learnings. Two rounds of data collection are complete.
• 24 clinics (target: 34 for the life of the project) now have access to safe water within the facilities, handwashing and sanitation infrastructure, supplies, and staff training.
• 275 healthcare facility staff received continued training in integrated management of childhood illness and infection prevention and control to help improve the quality of care provided.
• The program success has resulted in an approved expansion plan to bring clean water and healthcare improvements to every healthcare facility everywhere we work in Niger.

Check out this video for more on the Act 2 Save project

Uganda: In partnership with The Pfizer Foundation, the Expanding Access to Immunization and Treatment program aims to reduce mortality among 85,743 children under 5 in Bugiri by addressing childhood illnesses through curative and preventive interventions. The project objectives are to improve demand and uptake of child health services at the community level, strengthen systems and structures supporting child health interventions, and strengthen the child health information and supply system. The program launched in 2020 and, to date, has contributed to the following achievements:

• Identified 129,436 cases of malaria, diarrhea, and pneumonia among children under 5, and referred them
• Reached 178,806 people with education on disease prevention and management
• Supported 52 healthcare facilities with capacity building
• Trained 1,000 village health team members to actively provide iCCM
• Trained 144 health facility staff in integrated management of childhood illness and iCCM

Rwanda: The USAID-funded INGOBYI program (July 2018–May 2023) aimed to contribute to the reduction of infant and maternal mortality and the incidence of malaria in Rwanda by improving the availability of reproductive, maternal, newborn, and child health and malaria services with resilience and sustainability. Key objectives included improving health-seeking behaviors, strengthening existing savings groups to improve financial access to health services, creating awareness and opportunities for community-based health insurance, and empowering community members through local-level advocacy platforms.

The project covered 20 districts in Rwanda and key results included:

• 119 savings groups with 2,128 members were coached and mentored.
• Citizen Voice and Action trainings were held among 26 district referral hospitals.
• 11,720 participants engaged in local-level advocacy and developing score cards to identify strengths and weaknesses in health service delivery and how to be champions for change.

World Vision recognizes that adolescents face a variety of challenges that impact their ability to thrive:

• Around 1.1 million adolescents die of preventable causes every year. Millions more suffer from injury, sexual and mental abuse, and ill health.
• Adolescent girls ages 15 to 19 face the added risk of morbidity and mortality due to complications during pregnancy and childbirth. Twelve million girls in that range — and at least 777, 000 girls under 15 — give birth each year in developing regions. The leading cause of death for girls ages 15 to 19 globally is complications from pregnancy and childbirth.
• Child marriage (marriage before the age of 18) limits children’s abilities to reach their full potential, as they drop out of school prematurely; are at a much higher risk of complications related to early pregnancy, childbearing, and motherhood; and are at risk of intimate partner violence.

However, targeted comprehensive investments and opportunities in adolescent health — including education, socioeconomic development, and the prevention of violence — offer a chance for adolescents to flourish and become productive adults.

To address the physical, social, and mental health of adolescents, World Vision programming co-invests in education and keeping girls in schools, which may translate into reductions in early sexual debut and unintended pregnancies among adolescent girls. We also promote supportive parenting and communities, including activities that engage men and boys in livelihoods, HIV and AIDS prevention, and the prevention of forced child marriages. Additionally, improving WASH in schools leads to girls’ retention by allowing for dignified and safe menstrual hygiene management.

World Vision’s adolescent programming consists of intersectional and crosscutting interventions and approaches described below that seek outcomes in child protection, education, health, gender equality and social inclusion, and economic well-being. Adolescent health requires the intersection of these holistic approaches, which together work to address communities’ needs, and support and promote young people’s health and cognitive, social, emotional, and spiritual development.

Following are some examples of our holistic adolescent programming:

• Interpersonal Psychotherapy for Groups is an evidence-based mental health and psychosocial support group therapy intervention for 12- to 19-year-olds. It reduces symptoms of depression (and has shown some indications of being beneficial to reducing anxiety and harmful substance use, including alcohol) by improving the quality of the participants’ social and interpersonal functioning.
• Common Elements Treatment Approach is an evidence-based mental health intervention that is delivered in the community by laypeople and is used to address common mental health problems for adolescents and adults. World Vision, in partnership with Johns Hopkins University, piloted this model in secondary schools in India.
• Citizen Voice and Action (CVA) strengthens adolescents’ participation in decision-making, improves social accountability and local advocacy, and facilitates dialogue between communities and government to improve services (like education and child protection services) that impact the daily lives of adolescents and their families. As adolescents are often direct users of basic services, they play a powerful role in the CVA community meetings, often raising topics adults will not raise.
• Menstrual hygiene management includes providing separate latrines for girls in schools, safe disposal and/or water and soap stations for washing menstrual hygiene products, training adolescents to make reusable sanitary pads, and cultivating positive knowledge and behaviors toward menstrual health.
• Village Savings and Loans facilitate savings and access to small loans and instills hope by enabling adolescents to plan, cope with household emergencies, develop their livelihoods, and invest in their health, education, and economic well-being.
• Early Warning System tracks performance, attendance, and behavior at school and refers adolescent girls at risk for dropping out to a school-community accountability group that intervenes to keep girls in school.
• Channels of Hope mobilizes faith leaders and faith communities to meaningfully address (in contextually appropriate ways) gender and gender-based violence in its various forms in local communities.
• Psychological first aid (PFA) provides immediate support to an individual who is showing signs of psychosocial distress. When trained in PFA, helpers can offer PFA to children and adults following emergency situations, disclosure of abuse (e.g., child abuse, sexual- and gender-based violence), or at any point in time if a person is distressed. A facilitator’s manual and PFA manual are available in multiple languages. All staff working with children or families affected by violence should be trained in PFA skills.
• Girls Clubs are established at the community level to engage 30 to 50 girls ages 14 to 24 to build resilience and reduce risk of HIV infection and other vulnerabilities. These clubs are located in communities to reach out to schools and schoolgirls in need of adolescent services. Health information, promotion, and skills building are provided at the Girls Club activities.

The HIV epidemic disproportionately affects adolescent girls and young women (AGYW). Across the globe in 2019, an estimated 1.7 million adolescents were living with HIV and 190,000 were newly infected. Recent U.N. AIDS statistics indicate that in sub-Saharan Africa, AGYW are more than twice as likely to acquire HIV as their male counterparts due to gender-related factors, including harmful gender norms and taboos related to sexuality. However, keeping girls in school is one key way to help prevent child marriage, pregnancy, and gender-based violence — and reduce their risk of HIV infection.

In Uganda, the Strengthening School-Community Accountability for Girls’ Education (SAGE) program was a two-year U.S. President’s Emergency Plan for AIDS Relief-funded project implemented by World Vision and managed by John Snow Research and Training, Inc. Through SAGE, a component of the Determined, Resilient, Empowered, AIDS-free and Safe (DREAMS) project, World Vision implemented activities that aimed to reduce school dropouts and HIV infections among 38,750 AGYW in 151 secondary schools across 10 districts with some of the highest levels of dropouts and HIV infections.

The project implemented two adolescent-led, adult-supported innovations: 1) early warning system (EWS) and 2) stay in school committees (SISCs). The project trained school and community stakeholders, established AGYW-led SISCs in schools, and changed student attendance norms by promoting adolescent leadership and community action to reduce dropouts. The SISC uses the EWS to track school attendance, behavior, and performance. SAGE’s innovative combination approach also helped shift social norms and practices around girls’ education, violence against children, reproductive health, and positive discipline.

According to the endline survey findings, the percentage of AGYW who were absent from school for at least a month in a term during the last 12-month period dropped by 2.5 percentage points between baseline (12.7%) and endline (10.2%). Further, SAGE monitoring data reported an increase of girls retained in school at the end of the project (44,351), at 99.7% in 2019 (compared to 88.5% in 2016). For HIV status, the percentage of AGYW ages 15 to 19 who tested for HIV in the last 12 months and know their status increased by 3.8 points in the intervention/treatment areas, from 92.5% at baseline in 2017 to 96.3% at endline in 2018. The findings suggest that the combined EWS and SISC approaches are a potentially effective intervention to identifying girls at risk of dropping out of school, mitigating the causes of dropout, and potentially decreasing risky behaviors and reducing risk of HIV infection.

In India, we work with husbands and fathers through Men Care groups to help them challenge harmful gender norms and support and protect their wives and daughters from gender-based violence and harm, including child trafficking and early marriage. Girl Power groups equip and empower girls with information and resources to help keep themselves and their friends safe from abuse and trafficking.

In Kenya, World Vision dreams of a future without female genital mutilation (FGM) and child marriage. We are working to ensure that all girls and boys are cared for and protected from all forms of violence, while growing up within supportive families and communities. Through evidence-based strategies, our Kenya Big Dream project works to raise the visibility of violence against children and to change attitudes and behaviors. This involves not only educating and training parents, the community, government, and service providers, but also empowering girls and boys themselves. Turning the tide on child marriage and FGM requires a multisector approach to create lasting change. Following INSPIRE — WHO’s evidence-based strategies for best practices in child protection work — Kenya Big Dream changes social norms harmful to children, strengthens household economic conditions to reduce financial incentives for child marriage, promotes education and life skills training for girls, and more.

Access to education and healthcare is vital to girls who have undergone FGM, as well as girls who are likely to undergo the rite. The Kenya Big Dream project advocates at local and national levels to persuade the Kenyan government to fulfill its legal mandate to ensure children have access to high-quality education. Additionally, the project works for the economic empowerment of families, because when parents are financially stable and resilient, they place less pressure on young girls to marry in exchange for a bride price. Given this reality, World Vision is working with farmers to increase family incomes through technical trainings that facilitate access to markets with high-value crops and savings groups that help increase their savings and access to financial services.